Tried Raising Pressures, but it just keeps going up?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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robysue1
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Re: Tried Raising Pressures, but it just keeps going up?

Post by robysue1 » Fri Nov 25, 2022 3:05 pm

jlsmithseven wrote:
Fri Nov 25, 2022 1:47 pm
I tend to be very sensitive to pressure changes, so I was thinking when I raised my min. pressure if I could get closer to the pressure I am usually at when it raises, that I wouldn't wake up or cause me mini wakeups without realizing.
As someone who is fairly sensitive to all things CPAP/APAP related, I can sympathize with you and your suspicion that pressure increases could be causing some arousals/microwakes. You do have (on both days) times where you turned the machine off and back on, but the number of such times is not excessive---at least on paper.

Since you are concerned that you may be having arousals or mini wakes, regardless of the reason, you might want to use a smart watch or FitBit type device to track your sleep as well as looking at your CPAP data. Yes, such devices are far from perfect in terms of accurately detecting REM vs. non-REM sleep. But they're not that bad at detecting wake from sleep. I have my FitBit set to "sensitive" and I am (pleasantly) surprised that there is usually a strong correlation between "red dots" (i.e. short wakes) in the FitBit data and breathing patterns that are often assumed (around here) to be possible arousals/micro-wakes.

Such a device would give you another data point on trying to establish if sleep continuity is a serious problem for you. And if it is, correlating the wakes from the FitBit-type device or smart watch with your APAP data might help you tease apart whether the modest pressure increases you have with your APAP might be part of the problem.
My quality of sleep isn't exactly where I would want it, yes. I am a mouth breather and for most of this summer I have been using the Bleep Dreamports because 1. they dont leak, and 2. because there is no headgear. I've tried taping my mouth and using chinstraps and they help, but they aren't perfect.
Based on these two nights' data, what you are doing in terms of leak management appears to be acceptable in terms of the machine's ability to compensate. Yes, you have some leaks, but except for one 10-minute leak, none of the leaks are in Large Leak territory.

But the fact that you are worried about possible arousals/min-wakes causing your sleep quality to not be what you want it to be, it's worth asking whether the smallish leaks that you do have might be a culprit: Instead of pressure increases waking you up, is it possible that you are waking up because of the small leaks? Note: APAPs will compensate for small leaks by blowing more air into the leaky system in order to maintain the current set pressure. But sometimes people will subjectively interpret the APAP's leak compensation as an increase in pressure. (When the leak is really large, an APAP will decrease the pressure setting in an effort to help the mask reseal itself.)
On my second the night the pressure was just a bit too much for me I believe, and I also taped my mouth this night as well as the other night. The only difference is, the tape I had to take off the last few hours on the last night because my mouth was so dry i needed some water.
The pressure is not what's causing the dry mouth. It's the leaks. On Nov. 24 (the second night), you had some moderate-to-large leaks between 4:00am and 5:30am. I'm sure that the machine was pushing more air into the hose in order to compensate for what was being lost through your mouth. The machine did not increase the pressure because of the leaks, but the increased air flow needed to maintain the pressure can feel like a pressure increase when you're half asleep and wondering why there's so much air being blown at your nose and why your moth is so dry.
I know I don't sleep the same every night, but I believe my biggest issues with not being content consist of the following reasons:
1. I easily get caught up in the numbers game, rather than how I feel game.
2. I like to experiment to make things better
It's good to be aware of the pitfalls of getting caught up in a numbers game rather than the much more important "How I feel" game. Because "How I feel" is the real purpose of xPAP for most of us: We feel better when we sleep with our machine than when we don't.

And while it can be fun to experiment, it's important to have a goal in mind that is more specific than "make things better". You have to have some idea of what you are trying to make better. In your case, it seems that what you want to make better is sleep continuity. And the answer to that might not lie in dial-winging because the source of the perceived sleep continuity problem may or may not be related to your xPAP therapy.

Have you considered keeping a simple sleep log? In other words, have you considered writing down the following information when you wake up each morning before you look at your APAP data in Oscar:
  • How rested do you feel immediately on waking? (Keep it simple: 0 = Awful, 5 = Fantastic, with 3 = Decent.)
  • How long do you think it took you to get to sleep at the beginning of the night?
  • How many times do you remember waking up during the night?
  • How long (in minutes) do you think you were awake during the night? (Estimate this, and a range like 25-45 minutes, would be fine.)
  • What (if anything) do you remember about any wakes during the night? Was your mouth dry? Were you too hot, too cold, or otherwise uncomfortable in the bed? Did you get back to sleep in a reasonable amount of time?
It's also worth adding one more question to be filled in at the end of the day: How did you function/feel throughout the day? Again, keep this simple: 0 = Awful, 5 = Fantastic, with 3 = Decent.
If I did use CPAP mode, (ive thought about trying it in the past, but was scared that it couldnt reach the pressure it needed if i needed more), what pressure do you think would be good?
Yes, the downside to straight CPAP is that the machine can't increase pressure if it detects an event (or two or three) in an effort to prevent further events from happening. But the upside is that constant pressure is one less variable for your body to deal with when it is trying to learn how to sleep well with a mask on your face.

The usual advice for those who want to experiment with CPAP mode is to initially set the pressure at your long term 95% pressure setting: That should be enough to take care of all but your worst night's worst periods in terms of the OSA. But for the experiment to have any meaning, you also need to use CPAP mode for at least a week or so without any drastic changes in the pressure setting before jumping to conclusions about whether too many events are getting through the CPAP defenses.

In your specific case, your 95% pressure level over the last year has been 9.62 with an AHI = 1.54. In the last 6 months, your 95% pressure level has been 9.84 with an AHI = 1.57. In the last 30 days, your 95% pressure level has been 9.96 with an AHI = 1.24. The 7 day 95% pressure level is 10.48, which reflects the increase in your min pressure to 9.6 cm, with an AHI = 1.36.

Taken collectively, I'd say that it's reasonable to use something between 9.6 and 10.0 as a starting guess for a fixed pressure CPAP mode experiment. If I were you and I wanted to see if switching to CPAP mode seemed to reduce the number of potential wakes caused by pressure increases, then I think I'd start with 9.8 and see what the AHI is over the course of about a week. If it turns out that the AHI is over 3 for a day or two or you see some clustering of 5 or 6 (or more) events close together that concern you, then bump the pressure up by 0.2cm for the next night or two. You can keep adjusting the pressure by 0.2 increments until you either thing you are sleeping better (and you're happy enough with the AHI and the distribution of events) OR you decide the experiment is failing after a week or so of using straight pressure because you don't think your sleep has improved even though the AHI is about the same as it was with APAP.

If you realize that sleeping with a pressure of 9.8cm all night long (after the ramp goes off) is uncomfortable for an identifiable reason (too many leaks or simply too much discomfort when you do wake up), factor that into a decision that maybe you are actually better off with the modest pressure changes your current APAP settings create.



Here is the link to the other post I was talking about with the settings, I revert to these settings when I feel I've messed up too many things.
viewtopic.php?f=1&t=184598&p=1415051#p1415051
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jlsmithseven
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Re: Tried Raising Pressures, but it just keeps going up?

Post by jlsmithseven » Fri Nov 25, 2022 3:22 pm

Thanks again for the response. Yes I think you are spot on with most of your observations of what I am trying to achieve. I want sleep continuity. I've always struggled with waking up many times throughout the night, and I just remember one night last year, 2021, when I did not wake up once and slept for 8 hours I believe. It's like I had started a new life, I felt so amazing and just want to create that at least once a week would make me more than satisfied. I've taken other measures which have helped, and it might just be my lifestyle changes of having a 5 week old that has gotten me stressed, etc that I will need to get over. I've stopped drinking coffee past 2pm and I try to drink water more now as well. I believe my biggest reason for changing things is the ability to sleep through the night without being woken. I do have to take some feedings so that is inevitable, but I just want to recreate those amazing nights of sleep I had when I first started. I do occasionally sleep without the machine and my body feels worse, but my energy and mood stay the same all the time. I just can't get to that energy level I need/want.

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robysue1
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Re: Tried Raising Pressures, but it just keeps going up?

Post by robysue1 » Fri Nov 25, 2022 3:38 pm

jlsmithseven wrote:
Fri Nov 25, 2022 1:54 pm
I currently Use the Bleep Dreamports and tape sometimes when I feel like it. I wear ear plugs in both ears.
Why? And are the ear plugs comfortable?

I think my main worries are that the pressure changes are causing me mini wakeups that I dont experience, but my body does so it doesn't help me feel as rested.
I have no doubt something is disrupting your sleep. But the question is what that something is. And at this point, I'm not sure that it's pressure changes that are causing the suspected mini-wakes.

Consider this: You have EPR = 3. That means there is a 3cm change in pressure on each and every inhalation, all night long. But somehow you think a 1 or 2 cm increase in the base pressure setting is causing you to wake up. If pressure increases are the culprit, then it's reasonable to ask: Would you be better off turning EPR off?

The thing is, you probably find. EPR comfortable. And you probably find it much more easy to get to sleep with EPR = 3, but if your body can sleep with with the pressure changing on each and every breath by 3cm, it shouldn't be overly disturbed when the pressure increases by 1-2cm in response to flow limitations, snoring, or events.

My other worries are my mouth leaks which don't really show up in the charts, but I feel like it still leaks because I am a mouth breather.
You only need to worry about fixing leaks when one of two things happens:
  1. The leaks are large enough and long enough to adversely affect the efficacy of xPAP therapy
  2. The leaks are pesky enough to wake you up OR you are waking up with severe dry mouth problems.
Whatever you are doing to minimize your mouth leaks is working in terms of item (1). But it is quite possible that the leaks are causing some mini-arousals and micro-wakes. And in that case, it's not the leak data you need to worry about. It's trying to figure out whether leaks are waking you up and if so, what you might need to do.
I will admit I am trying this tongue retainer device soon and I am about to order a lower mouth guard to help some of my bruxism issues I've been dealing with recently.
Bruxism can cause micro-wakes and arousals. Taking care of them with the use of a properly constructed night guard may go a long way in fixing some of your current problems with sleep continuity.
I'm not sure if taping is recommended while wearing a mouthguard so i still have so much research to dive into.
I have no idea about whether to tape or not while using a night guard: While I have a double night guard (top & bottom) for my severe TMJ/bruxism problems, I've never been much of a mouth breather.

I guess at this point I'm wanting to try everything because I just don't wake up feeling rested like I used to.
Throwing everything, including the kitchen sink, at a problem usually does not work in fixing the problem.

One thing you need to consider is that when you try too many things all at one time, it's difficult to tell if any one of them is making either a positive or negative difference towards fixing the problem. As frustrating as it is, sometimes it's worth slowing down and giving your body an actual chance to adjust to the changes you are trying before you make more changes.

Could be because Winter is settling in and I have a 5 week old doesn't help anything either but I should be sleeping better.
Having a 5 week old guarantees that you are not going to get a decent night's sleep.

In all seriousness, parents of newborns are supposed to be sleep deprived: That's critical for the survival of their newborn, who cannot yet eat enough to sleep through the night. When my kids were five weeks old, they were still waking up every 2-3 hours needing to be fed and changed. I didn't breastfeed, so hubby and I could both take care of the feeding, but even if I had been breastfeeding, hubby would still have been doing a lot of the get up in the middle of the night to change the baby and bring the baby to me for breastfeeding.

Most infants will start sleeping more soundly through the sleep by the time they are somewhere between 3 and 6 months old. (And the first time it happened to us, both Hubby and myself woke up with a start scared something had happened to our daughter. We were relieved only after we found her alive and well and still asleep in her crib after a 5 hour stretch of sleep.) Even after the baby starts sleeping through the night, there will be plenty of nights where sleep is interrupted by the needs of the kid.

I'll end with: A sincere congratulations on the birth of your child. There's something really special about tiny infants, even though they do deprive you of your sleep.
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jlsmithseven
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Re: Tried Raising Pressures, but it just keeps going up?

Post by jlsmithseven » Fri Nov 25, 2022 7:56 pm

I really do appreciate all the well thought out responses it seems like you do genuinely care and it means a lot. What you were saying about the EPR was spot on and makes a lot of sense. We are also formula feeding and I do help most nights but I think my sleep is going to be constantly evolving and changing like you said. And thank you for the help.